Saturday, May 29, 2010

New research shows that a gene which is the major genetic risk factor for Alzheimer's disease (AD) may also influence the actual expression of the disease and account for some of the variations in the types of cognitive problems seen in patients with AD.

"This work provides proof of concept that genetics may not only impact the risk for dementia but also the nature of a dementia syndrome," said author David A. Wolk, MD, the author of a paper published online May 17 in an early edition of the Proceedings of the National Academy of Sciences United States of America.

Drs. Wolk and Bradford C. Dickerson, MD, investigated cognitive and neuroanatomical phenotypic variability in gene carriers and noncarriers with mild AD. Only patients proven to have AD on the basis of a cerebrospinal fluid molecular profile were studied. They found that APOE ε4 allele carriers displayed significantly greater impairment on measures of memory retention, whereas noncarriers displayed greater impairment on tests of working memory, executive control, and word retrieval. In addition, carriers exhibited greater medial temporal lobe atrophy, whereas noncarriers had greater frontoparietal atrophy.

"What was particularly remarkable about this study was the high correspondence between the differential effect of APOE status on cognitive symptoms and on evidence of brain atrophy," Dr. Wolk said.

Friday, May 28, 2010

It happens to all of us at one time or another. We’re in a conversation when and suddenly can’t remember the name of someone very familiar to us. We might even be able to visualize their face or remember the first letter of their name. It doesn’t even have to be a person’s name – it can be an object. There’s a name for this: The Tip of The Tongue Phenomenon, or TOT. I kid you not. The French term this Presque vu, for “almost seen.”

Reference to TOT appeared in non-academic literature as early as 1885 when Chekhov mentioned it in a short story. Harvard psychologists Roger Brown and David McNeill reported the first empirical investigation of the tip-of-the-tongue state in 1998. They recounted, "[t]he signs of it were unmistakable" and "he [a research participant] would appear to be in mild torment, something like on the brink of a sneeze, and if he found the word his relief was considerable." They reported that TOT is a fairly universal phenomenon occurring about once a week but will increase in frequency with age. While experiencing TOT we are often able to access the first letter of the intended word as well as remember related words.

Okay, but what causes it to happen?

Although it is safe to say no one knows for certain, the literature includes hypotheses that include both the psycholinguistic and memory oriented. Psycholinguists can get wrapped around the axel debating non-testable hypotheses, so I’ll not go into those. Suffice it to say from what I’ve been able to read about TOT, it appears to be like a temporary mild form of aphasia. We know the word but can’t pull it from memory. It’s frustrating and, often, the more we try, the more elusive the word is. And it’s usually after we stop trying the word pops back to the surface like a submerged balloon.

What we do know for sure is TOT happens at all age groups and becomes more frequent with age. This again suggests a memory problem because studies suggests that older adults remember less information about the intended word and thus have more difficulty resolving the TOT experience when it happens. It is a harbinger of dementia? Probably not. But like everything else, the symptom must be taken within the context of the broader neuropsychological examination.

Sunday, May 23, 2010

It’s been a while since I’ve contributed to this blog, but I’ve been swamped with work. Looks like CHOP SHOP will be released May 1, 2012. That’s a long way away, but it’s surprising just how fast deadlines creep up. For those of you who don’t know about it, it deals with the huge lucrative market for cadavers and assorted body parts. In doing my research for the story I was amazed to learn that selling bodies is illegal in most states. Yet every few years you read in the news about someone in a funeral home or coroner’s office who is busted for dealing. It’s rumored that a fresh body in good condition can fetch up to $300,000 dollars.

Some medical schools still use cadavers to teach anatomy, although this is becoming more the exception. It’s not that a supply of bodies is lacking, it’s that this gross anatomy is no longer considered essential curriculum in some schools. So how are bodies obtained by med schools? Because people will their bodies to “science,” usually to a local medical school. But this isn’t the need that drives the black market. Demand comes from a variety of parts that can be “salvaged” from a fresh body. Skin for grafting on burn patients, corneas to replace cloudy ones, bone for use in spinal fusions, This doesn’t count the need for the soft tissue organs used for transplants – kidneys, liver, hearts. I could go on and on, but I think you get the idea. For remain functional, organs such as kidneys, are usually harvested from living patients and immediately transplanted in the recipient. This because anoxia (being without oxygen) can severely damage them.

If you want to learn more about this intriguing but grizzly subject, keep an eye out for CHOP SHOP. I will, or course, push it on my website and send out the usual spam to anyone unlucky enough to be on my mailing list. The other books after SHOP will be STEM SELL and CUCKOO’S NEST. Stay tuned.

Thursday, May 13, 2010

Sorry if you came here looking for a new post. I've been snowed under with a ton of work. This week I signed a three book deal with Medallion Press for CHOP SHOP, STEM SELL, and CUCKOO'S NEST. These are all stand alones and SHOP will be comming out May 1, 2012. My agent Robert Astle wants me to adapt all three stories to screenplays. Shortly after DEAD HEAD was released, a Hollywood production company showed interest in optioning it. At the moment I'm also very involved in the International Thriller Writers association. I'll get back to posting new material here as soon as I can come up for breath. Keep checking, I'll be posting again soon.

Friday, May 7, 2010

I’m a supporter of legalizing marijuana. For a variety of reasons. But first, some history. I doubt that most readers realize that the drug was legal in the United States until 1906 when the first pprohibitions of cannabis were instated. By the mid-1930s, cannabis was regulated in every state by laws instituted through The Uniform State Narcotic Act. In the 1970s, some states started to decriminalize cannabis. Most places that have decriminalized cannabis have one or more of civil fines, drug education, drug treatment in place of incarceration, criminal charges for possession of small amounts of cannabis, or have made various cannabis offenses the lowest priority for law enforcement. In the 1990s many states began to legalize medical cannabis. This conflicts with federal laws because cannabis is a Schedule I drug according to the Controlled Substances Act of 1970. (The DEA classifies drugs into several tiers based on numerous criteria. To prescribe medications, physicians must have a license and prescribe only within the levels for which they’re licensed.) Washington, where I live, approved the use in 1998 for any medical condition in which the “potential benefits of the medical use of cannabis would likely outweigh the health risks.” Patients diagnosed with cachexia; cancer; HIV or AIDS; epilepsy; glaucoma; and multiple sclerosis are given legal protection under this act. Other medical conditions are subject to approval by the Washington Board of Health.

In Washington State patients may legally possess or grow no more than a 60-day supply of cannabis. The American Medical Association and the California Medical Association have both, separately, called for more research on Marijuana. “...CMA considers the criminalization of marijuana to be a failed public health policy; and be it further resolved that CMA encourage and participate in debate and education regarding the health aspects of changing current policy regarding cannabis use.”

My personal and professional opinion is that marijuana is no more physically harmful or carry more potential for abuse than does alcohol. Certainly, the most addictive legalized drug presently available to citizens is tobacco. With increasing medical costs and decreasing ability to fund these costs, a reasonable tax on legalized marijuana would be another revenue source.

Tuesday, May 4, 2010

Got a couple comments on my April 21 blog about memory. Both referred to a segment on the TV show 60 Minutes in which the use of Adderall in college campuses to facilitate studying was discussed. I didn’t see the show, but apparently students are using the drug to help cram for exams.

Adderall is the brand-name for a psychostimulant (a stimulant or “upper”) medication that is used commonly to treat people with ADHD because such patients often have a paradoxical reaction to it. Instead of becoming stimulated, they are calmed down. Adderall is also used to treat Narcolepsy (see the April 30 blog). It requires a prescription drug and may or may not be addictive depending upon the addictive potential of the individual using it. The drug is thought to work by increasing the amount of two neurotransmitters (see earlier blog), dopamine (which is deficient in Parkinson’s disease) and norepinephrine. Its main effect is to increase alertness, libido, concentration, and overall cognitive performance while decreasing user fatigue. So it’s easy to see why students might use it. It is available in two formulations – an instant release and extended release. It is a cousin to methamphetamine and dextroamphetamine and there is some dextroamphetamine in both formulations.

Use of uppers by students is not new and started when amphetamines were first introduced in the 60s as “diet pills.” In fact, when Shire, the pharmaceutical firm that introduced Adderall in 1996, did so as an obesity treatment. Since then pediatricians have tumbled to the fact that it is effective for treating some children with ADHD.

As is the case with all drugs, there is the potential for “off label” use – using the drug for indications not approved to be on the dispensing label. Off label use is not illegal. Physicians commonly prescribe drugs for indications not officially approved by the FDA. As an example, Tegretol, a widely used anticonvulsant was initially introduced for treatment of trigeminal neuralgia. Neurologist quickly adopted the medication to treat seizure disorders. It wasn’t until a decade later, after clinical trials demonstrated it’s anticonvulsant effect, that the FDA approved it for that use.

This issues raised by the two blog readers is a good one. Is the use of a psychoactive drug for the purposes of studying bad? Probably not. In actuality, it’s not much different than brewing a pot of strong coffee for a night of cramming. The difference, of course, is that caffeine does not require a prescription. Both caffeine and Adderall can be addictive, so the difference here is how to obtain the drug. Most doctors will not prescribe it as a study aid, so it is commonly obtained illegally.

I thank the two readers who raised this question. As I've written before, please ask questions about the brain and brain function.